“According to the wisdom of various Asian proverbs, to have a son is “good economics and good politics” and “as essential as taking food at least once a day.” A boy’s birth is attended by a variety of celebrations and likened to “a sunrise in the abode of gods.” For girls, however, the axioms are very different. Being labelled an abu-banat in Arabic is to be insulted as the “father of daughters”, and one adage in India likens raising a daughter to “watering the neighbor’s garden.” In certain parts of Pakistan, an “endearment” for daughters roughly translates as “May you die.””

The expendable girl child

Around the globe, many girls die because of the lesser value accorded to them. The United Nations Children’s Fund (UNICEF) estimates that more than one million female babies succumb each year as a result of inequitable access to healthcare, differential feeding and other forms of neglect. Some researchers put the global number of “missing” females – those who should currently be living but are not because of discriminatory practices – to between 50 million and 100 million, telling “a terrible story of inequality and neglect.”

Existing in various forms and across many cultures, son preference included a broad spectrum of customs and rituals, the foundations which are favoritism towards male children with concomitant disregard for daughters. In almost all cultures, it is the sons who carry the family name, making male progeny essential to the propagation of the family linage. In many societies, a daughter is destined in marriage to live with her husband’s family. The responsibility for the care of aging parents often falls to sons, who not only support their parents in their dotage, but also perform their parents’ burial rights, especially in communities throughout Asia and Africa. At the very least, not having a son is a source of vulnerability for parents in this life; at its worst, it may prevent mothers and fathers from “securing peace in the next world.”

While scientific data on the prevalence and effects of discriminatory practices against females is very difficult to obtain, population sex ratios, birth sex ratios and infant – and child-mortality rates often are used as indicators to assess son preference. According to the World Health Organization (WHO), regions where son preference is most apparent include Asia (China, Bangladesh, India, Korea, Nepal, Pakistan, Taiwan), the Middle East (Iran, Jordan, Syria, Saudi Arabia, Turkey) and most parts of Africa (Algeria, Egypt, Libya, Morocco, Tunisia, Cameroon, Liberia, Madagascar, Senegal), as well as Latin America (Bolivia, Colombia, Ecuador, Mexico, Peru, Uruguay).

Although the most typical demonstration of son preference is the neglect of daughters, its most extreme form is female infanticide, or the intentional killing of baby girls. Infanticide of either, sex, whether for economic, social or other reasons, has been prevalent across cultures throughout history. Even today, infants under one year of age in the United Kingdom are “four times as likely to be victims of homicide as any other age group – almost all killed by their parents.”

Infanticide specifically targeting females, however, has largely been supplanted – at least for those who have access to modern technology – by preventing the birth of girls through sex-identification testing and sex-selective abortion, representing “a substitution of prenatal discrimination for postnatal discrimination.” Most pronounced in India, China, Korea and Taiwan, much of the contemporary research on pre-birth sex selection, as well as its historical cousin, female infanticide, focuses on the world’s two most populous countries: India and China.

Prebirth sex selection and female infanticide in India

Based on extrapolations from the 1991 census, approximately 35 million to 45 million females were concluded “missing” in India, a finding which repeated itself in the 2001 tally. In that year, 933 women were enumerated for every 1,000 men. Ratios in specific states in the north of India were even more dramatic and as low as 861 women per 1,000 men. Some of those among the missing are never even born: An estimated 106,000 female fetuses are aborted in India every year following sex-identification testing. A significantly lower number may be killed as newborns – poisoned, suffocated, burned or buried alive. According to one father, “If we kill female babies immediately after their birth, the chance of having a male son is very high.”

Outlawed by British in 1870, female infanticide still retains a foothold in some areas northwest India, where the practice has a long history. In a human rights survey in 2000, the State Department of the United States estimated that there are 10,000 cases of female infanticide annually in India. One traditional practice was to feed unwanted girls milk laced with poison or shredded paddy husk, the latter slitting a baby’s tender throat as it was swallowed. In the face of modern postmortem examination technology, however, today’s methods have become more strategic. A women in Tamil Nadu dispassionately explained how things have changed: “We no longer kill the girl baby with the poisonous sap of the oneander plant, as traces of the poison can be detected. We make the death appear natural. For instance, we starve the baby to death or asphyxiate it.”

Female infanticide, however, has not been perpetrated with complete indifference. Elaborate traditional ceremonies were designed to absolve parents of wrongdoing. According to one Indian custom, after an infant girl is killed, the parents bury her in the room in which she was born and plaster the floor with cow dung to purify the site. Thirteen days after the death, a village priest – a Brahman – must cook a meal using ghee (clarified butter) and eat it in the room. By doing so, he “takes the sin of killing the baby upon himself.”

Given this moral ambivalence towards killing girl infants, it is not surprising that modern methods of fetal sex identification and pregnancy termination have replaced infanticide as the preferred way for some families in India to control the number of daughters they have. Abortion under certain circumstances was legalized in India in 1971. Since then, it has become a burgeoning business, especially for the purposes of sex selection. From 1982 to 1987, the number of sex-determination clinics in Bombay grew from fewer than 10 to 248. One study from that period revealed that of 8,000 abortions performed in Bombay in a single year, 7,999 were female fetuses. In a study of one Bombay hospital, 430 out of 450 female fetuses were aborted, while none of 250 male fetuses were – even when there was evidence of a genetic problem.

Birth order also plays its part in sex-selective abortions. The higher the birth order, the greater likelihood a female fetus will be aborted. While it is generally accepted that one girl is needed “to light the lamp” in each home, a second or third daughter might be viewed as a liability.

Another national legislation criminalizing sex-determination testing was introduced in the mid-1990s, recent research suggests that sex-selective abortion continues to flourish in India as a method for controlling family composition. Some experts argue that disproportionate sex ratios where men increasingly outnumber women will eventually elevate the status of women by creating a greater demand for wives, leading to positive reforms in the dowry system in India. Others contend, however, that sustained sex-ratio imbalances do “not improve the status of women, [but rather] … reflect it.” In the last century, such imbalances increased steadily from 972 women per 1,000 men in 1901 to 930 women per 1,000 in 1971. For the following 30 years, they remained virtually unchanged, fluctuating between 927 and 933. In the meantime, dowry payments have increased significantly, and dowry crimes and many other forms of violence against women do not appear to be abating.

Beyond perpetruating gender-based discrimination, sex-selective abortion triggers a host of other negative repercussions for women and girls. Because the primary modes of sex determination among the lower classes are amniocentesis and ultrasound – the first unavailable and the second unreliable until the second trimester – sex selection often leads to late-term abortions, which in turn can cause an array of reproductive-health problems for pregnant women. In addition, more girls may be wed at a younger age due to a scarcity of marriagable women, further contributing to the poor status of women as these young brides are less likely to complete their education and are less likely to suffer increased morbidity and mortality associated with early child-bearing.

The declining sex ration could also stimulate an increase in prostitution, as well as other forms of exploitation and violence against women. In India, women reportedly have been “imported”, internally and from Bangladesh, to areas where sex ratios are dramatically low. According to one account, these women are “treated as slaves, and subjected to physical and sexual abuse.” Whether or not trafficking and other forms of violence against women can be attributed directly to sex-ratio imbalances remains an area for further investigation.All text is copyright (IRIN). Full permission is given for reproduction for non-commercial purposes.

Sexual violence against women in war and its aftermath can have almost inestimable short and long-term negative health consequences. As a result of the systematic and exceptionally violent gang rape of thousands of Congolese women and girls, doctors in the DRC are now classifying vaginal destruction as a crime of combat. Many of the victims suffer from traumatic fistula — tissue tears in the vagina, bladder and rectum. Additional long-term medical complications for survivors may include uterine prolapse (the descent of the uterus into the vagina or beyond) and other serious injuries to the reproductive system, such as infertility, or complications associated with miscarriages and self-induced abortions. Rape victims are also at high risk for sexually transmitted infections (STIs). Health clinics in Monrovia, Liberia, reported in 2003 that all female patients — most of whom said they had been raped by former government soldiers or armed opposition — tested positive for at least one sexually transmitted infection. Untreated STIs can cause infertility — a dire consequence for women and girls in cultures where their value is linked to reproduction. STIs also increase the risk of HIV transmission. HIV/AIDS is among the most devastating physical health consequences for survivors of sexual violence — as evidenced by the continued suffering of women in Rwanda. In a study of over 1,000 genocide widows undertaken in the year 2000, 67 percent of rape survivors were HIV-positive. In the same year, the United Nations Secretary-General concluded, “Armed conflicts … increasingly serve as vectors for the HIV/AIDS pandemic, which follows closely on the heels of armed troops and in the corridors of conflict.” Despite the level of recognition of the urgency of the problem of HIV/AIDS in war, insufficient resources have been dedicated to addressing the issue. In Rwanda, as elsewhere, treatment for rape victims infected with HIV has been characterised as “too little, too late.” The story of one HIVpositive victim of the genocide illustrates the tragic consequences:

“Since I learned I was infected [in 1999], my husband said he couldn’t live with me. He divorced me and left me with three children, so now I don’t know how to pay for food, rent, school and so on. I have no family left. My six-year-old has many health problems, and she must have HIV. She should be on antiretrovirals, but there isn’t the money. Since I was married after the war, it is difficult for me to access help from the Genocide Survivor’s Fund. My greatest worry is what will happen to my children if I die. I want to get sponsors for them, so at least I can die in peace.”

The challenges of meeting the myriad health needs of survivors of warrelated sexual assault are complicated by the absence of adequate facilities and trained staff in many war-torn settings. In research conducted in post-conflict Timor Leste and Kosovo, and among internally displaced women in Colombia, over two-thirds of women interviewed reported that reproductive-health services were difficult to access. Even where services do exist, they may not be free — as is the case in many countries in Africa, where state-run health centres operate on a cost-recovery basis. Moreover, many health clinics are constructed with open waiting areas where women and girls may be expected to disclose their reasons for seeking care; in the absence of confidentiality, they are likely to conceal their victimisation. Health workers’ beliefs that it is their responsibility to “prove or disprove” rape is also a limiting factor in quality of care. In some settings, a woman seeking medical treatment may be required first to report her case to the police in order to get a medical referral. This prerequisite, in turn, may expose women to further violence. Rape victims in Darfur, for example, have been arrested for “illegal” pregnancies (occurring outside the context of marriage). One 16-year old Sudanese girl, who had already suffered the rejection of her family and fiancé, endured additional abuse at the hands of police:

“When I was eight months pregnant from the rape, the police came to my hut and forced me with their guns to go to the police station. They asked me questions, so I told them that I had been raped. They told me that as I was not married, I will deliver this baby illegally. They beat me with a whip on the chest and back and put me in jail. There were other women in jail who had the same story. During the day, we had to walk to the well four times a day to get the policemen water, clean and cook for them. At night, I was in a small cell with 23 other women. I had no other food than what I could find during my work during the day. And the only water was what I drank at the well. I stayed 10 days in jail and now I have to pay the fine — 20,000 Sudanese dinar [$65] they asked me. My child is now two months old.”

For those who are subject to discrimination by family and community, and who also do not receive basic psychological support, the emotional effects of their violation may be as debilitating as any physical injuries. Many rape survivors in Rwanda reportedly “still live under a constant shadow of pain or discomfort which reduces their capacity to work, look after and provide for their families.” One such survivor, who was gang raped and beaten unconscious during the genocide, woke up only to witness the killing of people all around her. Ten years later, she says:

“I regret that I didn’t die that day. Those men and women who died are now at peace whereas I am still here to suffer even more. I’m handicapped in the true sense of the word. I don’t know how to explain it. I regret that I’m alive because I’ve lost my lust for life. We survivors are broken-hearted. We live in a situation which overwhelms us. Our wounds become deeper every day. We are constantly in mourning.”

The implications of such testimony make clear the fact that programming to assist survivors is imperative to any lasting efforts at reconstructing the lives and livelihoods of individuals, families and communities in the wake of armed conflict. In most conflict-affected settings, however, human rights and humanitarian activists are still fighting to ensure that the most basic services are accessible. The ultimate goal — putting an end to the epidemic of sexual violence against women and girls during war — seems an even more distant aspiration than developing adequate response services.

Assisting and protecting survivors

International humanitarian initiatives aimed at addressing violence against women in refugee, internally displaced and post-conflict settings are relatively new. Most have been introduced only in the last 10 years. Particularly during the late 1990s, a number of relatively small-scale but nonetheless vital projects were implemented in various sites around the world. The lessons learned from these efforts gave rise to a theoretical model, currently promoted by UNHCR and others, that recognises the importance of integrating prevention and response programming within and across service-delivery sectors, specifically in the areas of health, social welfare, security and justice. In other words, survivors must have access to medical care as well as psychosocial assistance; they should be able to rely on the protection of the police, peacekeepers and local military; and they are entitled to legal assistance should they choose to prosecute those who perpetrate violence against them. Addressing sexual violence also requires national education and sensitisation — at the family and community level and at the level of service provision — so that doctors, lawyers, judges and police are able to respond to survivors efficiently, effectively and supportively. It further requires advocating for improved legislation to protect women and girls, as well as policies that support gender equity and equality.

While the broad outline of roles and responsibilities within this “multisectoral model” provides a general framework for addressing violence against women, an assessment undertaken in 2001 concluded that the implementation of the model was weak in virtually every conflict-affected setting around the world. Foremost among the limitations to establishing multisectoral programming was the failure — at both the international and national levels — to prioritise violence against women as a major health and human rights concern. The result was a lack of financial, technical and logistical resources necessary to tackle the issue. Many survivors, the 2001 assessment observed, were not receiving the assistance they needed and deserved, nor was sufficient attention being given to the prevention of violence. The outcomes of an independent experts’ investigation spearheaded by the United Nations Development Fund for Women the following year echoed these findings in their conclusion “that the standards of protection for women affected by conflict are glaring in their inadequacy, as is the international response.”

These inadequacies persist even today. However, the number of fieldbased initiatives addressing the issue of sexual violence against women and girls continues to grow, even against a wearisome backdrop of limited funding. Methodologies are being refined by many humanitarian organizations to try to extend and improve services for survivors, as well as to build the capacity of local agencies to take on the issue. Standardised procedures for medical management of rape are being adopted in an increasing number of settings. Training modules have been developed to build local capacity to meet the psychosocial needs of survivors. Efforts are being made, most evidently in post-conflict settings but also in some refugee settings, to support legal reforms that would provide greater protection against multiple types of gender-based violence against women and girls.

Widespread community-based education aimed at changing attitudes and behaviours that promote sexual and other forms of violence against women has been carried out in a number of settings. Research on the nature and scope of the problem has also multiplied in recent years, and is bringing pressure to bear on international actors as well as on states to take more aggressive measures to address violence against women in conflict and its aftermath.

In addition, several high-level international initiatives are currently underway to promote more coordinated and comprehensive action by humanitarian aid organizations. New guidelines issued by a task force of the United Nations Inter Agency Standing Committee (IASC) provide detailed recommendations for the minimum response required to address sexual violence in emergencies and hold all humanitarian actors responsible for tackling the issue in their respective areas of operation. The IASC released a statement in January 2005 reconfirming their commitment to “urgent and concerted action aimed at preventing gender-based violence, including in particular sexual violence, ensuring appropriate care and follow-up for victims/survivors, and working towards holding perpetrators accountable.”

To this end, a global initiative to “stop rape in war” is being developed collaboratively by United Nations entities and nongovernmental organizations. The two major pillars of the initiative include conducting advocacy at the international, regional, and local levels, and strengthening programming efforts among those currently engaged in addressing the issue of sexual violence in conflict. One of the notable outcomes of the proposed initiative is to reduce the prevalence of rape in target countries by at least 50 percent by 2007. Such ambitions will require a “quantum shift” in approaches to sexual violence in war, most especially in terms of prioritising all efforts to end the levels of impunity that have given rise to the “shocking scale and stubborn persistence” of the violence.

The final frontier: ending impunity

Along with an increase in field-based programming, the last decade has produced significant advances in international standards and mechanisms of accountability for those who commit sexual violence. International criminal tribunals for Rwanda and the former Yugoslavia have prosecuted sexual violence as crimes of genocide, torture, crimes against humanity and as war crimes. The Rome Statute of the recently established International Criminal Court (ICC) has enumerated rape, sexual slavery and trafficking, enforced prostitution, forced pregnancy, enforced sterilisation and other forms of sexual violence and persecution as crimes against humanity and as war crimes. The ICC is initiating investigation into cases from several conflict-affected countries. Another groundbreaking advance was the United Nations Security Council’s adoption of Resolution 1325 in 2000, which specifically “calls upon all parties to armed conflict to take special measures to protect women and girls from gender-based violence, particularly rape and other forms of sexual abuse, and all other forms of violence in situations of armed conflict.” Since that time, the United Nations Secretary-General has submitted two reports to the United Nations Security Council on the implementation of Resolution 1325. While these reports concede that much remains to be done, especially in terms of holding states accountable for the actions of fighting forces and in increasing the level of participation of women in all stages of peace-building, they also note that major advances have been made in introducing codes of conduct that establish “zero tolerance” for all United Nations personnel, including peacekeepers, who might sexually exploit those they are meant to serve. Since these codes of conduct were implemented, action has been taken against offenders in a number of countries, such as the DRC, where an inquiry into allegations of sexual exploitation committed by over 100 peacekeepers is underway. However, grave problems with impunity persist in virtually every conflict-affected setting around the globe. International tribunals can only prosecute a fraction of cases, and many national governments do not have the resources or the commitment to pursue the perpetrators of sexual crimes against women. In some cases national jurisdiction does not extend to foreign fighting forces who commit abuses within their territory. In others, governments do little to support victims in coming forward. Evidentiary requirements often mean that the burden of proof lies with the victim. Some must pay for legal assistance. Where forensic evidence is required, healthcare providers must be able to collect it in a timely manner and be prepared to present that evidence at a trial. Police or relevant security forces must be trained to investigate and appropriately document their findings. The frustrating reality for many survivors of sexual crimes in conflict-affected settings around the world is that there are no systems to ensure basic protection to survivors, let alone access to justice.

Such impunity both reflects and reinforces the widespread cultural norms that acquiesce to the inevitability of violence against women and girls whether in times of peace or of war. And it is these norms that must be targeted aggressively in order to ensure reductions in levels of abuse:

“In a world where sex crimes are too often regarded as misdemeanours during times of law and order, surely rape will not be perceived as a high crime during war, when all the rules of human interaction are turned on their heads, and heinous acts regularly earn their perpetrators commendation. … What matters most is that we combine the new acknowledgement of rape’s role in war with a further recognition: humankind’s level of tolerance for sexual violence is not established by international tribunals after war. That baseline is established by societies, in times of peace. The rules of war can never really change as long as violent aggression against women is tolerated in everyday life.”

In a world where thousands of women and girls suffer sexual violence committed with impunity in the context of conflict, the message needs to be made clear: A single rape constitutes a war crime.

“By 1993, the Zenica Centre for the Registration of War and Genocide Crime in Bosnia-Herzegovina had documented 40,000 cases of war-related rape. Of a sample of Rwandan women surveyed in 1999, 39 percent reported being raped during the 1994 genocide, and 72 percent said they knew someone who had been raped. An estimated 23,200 to 45,600 Kosovar Albanian women are believed to have been raped between August 1998 and August 1999, the height of the conflict with Serbia.

In 2003, 74 percent of a random sample of 388 Liberian refugee women living in camps in Sierra Leone reported being sexually abused prior to being displaced from their homes in Liberia. Fifty-five percent of them experienced sexual violence during displacement. Of a sample of 410 internally displaced Colombian women in Cartagena who were surveyed in 2003, 8 percent reported some form of sexual violence prior to being displaced, and 11 percent reported being abused since their displacement.

The changing face of war

A growing body of data from the wars of the last decade is finally bringing to light “one of history’s great silences”: the sexual violation and torture of civilian women and girls during periods of armed conflict. Until recently, the evidence — along with the issue — had been generally ignored by historians, politicians and the world at large, yet it is hardly new. The licence of victors to “rape and pillage” the vanquished dates back to Ancient Greek, Roman and Hebrew wars. In examplesfrom the last century alone, Jewish women were raped by Cossacks during the 1919 pogroms in Russia; the Japanese military trafficked thousands of “comfort women” from countries across Asia and sexually enslaved them during World War II; over 100,000 women were raped in the Berlin area directly following World War II; and hundreds of thousands of Bengali women were raped by Pakistani soldiers during the 1971 Bangladeshi war of secession.

Despite the history of sexual violence committed against women and girls by men in times of war, what is especially disturbing about the statistics from the past 10 years is how rife the phenomenon appears to have become. It might be argued that the current data simply reflect greater international attention to the issue — provoked in part by the media coverage of the sexual atrocities committed during the conflicts in the former Yugoslavia and Rwanda, and even more importantly by the decades of intensive awareness-raising by women’s activists around the world — rather than a significant rise in absolute numbers of victims. A more likely explanation, however, is that the nature of warfare is changing, in ways that increasingly endanger women and girls. Since the latter half of the last century, combat primarily limited to military engagements between national armies has been largely supplanted by civil wars and regional conflicts that pit communities along racial, religious and/or ethnic lines. The result is that civilian populations are victimised on a massive scale. Between 1989 and 1997, an estimated 103 armed conflicts were launched in 69 countries across the world. Civilian casualties during these more recent conflicts are estimated to be as high as 75 percent, a stunning contrast to the 5 percent estimate from the start of the last century. Although overall more men than women continue to die as a result of conflict, women and girls suffer myriad debilitating consequences of war. So much so, according to a 2002 report of the Secretary-General of the United Nations, that “women and children are disproportionately targets” and “constitute the majority of all victims” of contemporary armed conflicts.

What the current data conceal

However disturbing the current statistics are, they probably conceal more than they reveal in terms of the true extent of sexual violence against women and girls during armed conflict. For a number of reasons, data on rape in war are exceedingly difficult to capture — as seen in the sometimes dramatic variance in estimates from any given country, such as those from Bosnia that range from 14,000 to 50,000, and from Rwanda that range from 15,700 to a half million. Sometimes the discrepancies reflect political interests, where a government or armed group may seek to downplay the extent of crimes committed by its members, while others are working to highlight those crimes. Yet even when research is undertaken by nonaligned human rights or other groups, obtaining an accurate representation of the scope of sexual violence presents tremendous challenges.

Research on sexual violence against women during war is in its relative infancy. Investigators have only just begun to develop and test methodologies for collecting representative data. In addition, substantial underreporting of rape is commonplace even in times of peace; in times of war and its aftermath, when constraining factors such as stigma and shame are compounded by political instability and threats to personal safety, rates of reporting are likely to be even lower. Exposing violence in the context of active conflict can represent a security risk for all involved — as evidenced by the May 2005 arrest of the Médecins Sans Frontières (MSF) head of mission in Khartoum, Sudan, who was charged by the Sudanese government with crimes against the state after publishing a report on women seeking rape-related medical treatment in MSF facilities throughout Darfur.

In many more instances, there is simply no insitutional authority or organization to whom a woman can recount her experience. Even where services do exist, pervasive impunity for perpetrators of war-related sexual violence means that many survivors may accurately reason that no justice — and thus no purpose — will be served by reporting their victimisation. Notably, in a 2001 study from Timor Leste (East Timor), only 7 percent of women who had experienced physical or sexual violence during the crisis of 1999 ever reported their victimisation to a local authority. In a survey from Rwanda, only 6 percent of respondents who had been raped during the genocide ever sought medical treatment.

The current statistics — detached as they are from the nature of the crimes — also do not reveal the depths of violence to which women and girls have been exposed, or the terror they are forced to endure when their bodies become the ways and means of war. It is only the personal accounts that do this — accounts that most of the world will likely never hear.

Three personal stories

Since the 1996 outbreak of hostilities among multiple armed factions in the eastern part of the Democratic Republic of Congo (DRC), atrocities against women have been so horrific and extensive that the violence has been referred to colloquially as the “war within a war” and the “war against women”. Although a peace process was initiated at the end of 2002, the prevailing lawlessness in the eastern part of the country continues to put many women and girls at risk. In recent research in South Kivu, 492 women — 79 percent of whom had been sexually assaulted by between two and 20 attackers — shared their experiences of rape, mutilation and torture. One incident was related by a victim still confined to a hospital bed:

“A few moments after the Interahamwe [Rwandan militia] arrived in the village I heard my neighbour screaming. I looked out of the window and I saw some men, all holding rifles. Immediately, I wanted to run away and hide but three of them turned up at our house. My husband pretended to be asleep … they grabbed me roughly. One of them restrained me, while another took my pili pili pestle and pushed it several times into my vagina, as if he was pounding. This agony seemed to be a neverending hell … then they suddenly left. For two weeks my vagina was discharging. I was operated on … I have to relieve myself into a bag tied to an opening in the side of my belly. They also killed my husband and my son.”

In another instance, a Congolese woman described the brutality she endured at the hands of militia:

“I was busy cutting wood, when four armed men suddenly appeared at the other end of the field. They told me to undress and to volunteer myself to one of them. I refused. Then they took me, spreading my legs out and tying them, one to the bottom of a tree, the other to another tree trunk. They stuck my head between two sticks held diagonally, so that I couldn’t sit up without hurting myself. I stayed in this position and one of the attackers penetrated me forcefully from behind in the vagina, and the other pushed his penis into my mouth, right into my throat … I was retrieved by neighbours who watched my ordeal from a distance. When they found me I had fainted and was covered in blood.”

Similar atrocities were committed by all parties to Sierra Leone’s 10-year civil war. The primary perpetrators of the most egregious abuses, however, were among the rebel forces, particularly the Revolutionary United Front. They raped as a matter of course, often in gangs, often in front of family members. They forced boys and men to rape their mothers and wives. They sexually assaulted and then disemboweled pregnant women. They mutilated women’s genitals with knives, burning wood and gun barrels. One particularly violent rebel incursion, on the capital city of Freetown in January 1999, let loose a “hellish cycle of rape, sexual assault, and mutilation.” A 13-year-old girl, abducted during the incursion and forced into sexual slavery by rebels, already had given birth to a baby girl born of rape by the time she told her story to researchers in 2001. She remembered how her captivity began:

“We were taken to a house with about 200 people in it. My older cousin was sent to go and select 25 men and 25 women to have their hands chopped off. Then she was told to cut off the first man’s hand. She refused to do it, saying she was afraid. I was then told to do it. I said I’d never done such a thing before and that I was afraid. We were told to sit on the side and watch. So we sat. They chopped off two men’s hands. My cousin couldn’t watch and bowed her head down to avoid the sight. Because she did that, they shot her in the foot. They bandaged her foot and then forced her to walk. We left the two men whose hands had been cut off behind. We were then taken to a mosque in Kissy. They killed everyone in there. … They were snatching babies and infants from their mother’s arms and tossing them in the air. The babies would free fall to their deaths. At other times they would also chop them from the back of their heads to kill them, you know, like you do when you slaughter chickens. One girl with us tried to escape. They made her take off her slippers and give them to me and then killed her. … One time we came across two pregnant women. They tied the women down with their legs eagle spread and took a sharpened stick and jabbed them inside their wombs until the babies came out on the stick.”

The “murderous madness” of sexual violence in conflict

The motivation for rape committed during armed conflict varies. The violence can be a by-product of the collapse in social and moral order that accompanies war. In DRC, rape has become so indiscriminate as to be referred to as “murderous madness”. In one example, a Congolese mother walked into her house to find a paramilitary raping her 10- month-old baby. Such incidents are not only limited to combatants. Men from the local community may exploit the chaos of conflict to commit sexual violence against women without fear of punishment.

Under the volatile and disorganized rule of the Mujahideen, for instance, rape and sexual assault in Afghanistan’s capital city of Kabul were reportedly so commonplace that the oppressive police state established after the Taliban takeover in 1996 was initially perceived by some women as a welcome reprieve.

Sexual violence may also be systematic, carried out by fighting forces for the explicit purpose of destabilising populations and destroying bonds within communities and families. In these instances, rape is often a public act, aimed to maximise humiliation and shame. In Timor Leste, Indonesian military reportedly raped women in front of their families and forced Timorese men to rape Timorese women.

Researchers on a 2004 fact-finding mission to Northern Uganda, where an 18-year insurgency by the Lord’s Resistance Army (LRA) continues, spoke with one man who was commanded by members of the LRA to have sex with his daughter:

“I refused. … They ordered my son … for the fear of a cocked gun he complied. … I was then forced to have sex with a hole they had dug in the floor using a knife. … They forced my private part in the hole several times — the skin was totally destroyed. … It was impossible to fight someone who is armed. … This was all done in front of my wife, son, and the daughter. … My wife went mad.”

A Sudanese man recounted to researchers his family’s similar degradation in Darfur: “In February 2004, I abandoned my house because of the conflict. I met six Arabs in the bush. I wanted to take my spear and defend my family, but they threatened me with a weapon and I had to stop. The six men raped my daughter, who is 25 years old, in front of me, my wife and young children.”

Sexual violence also can serve to quell resistance by instilling fear in local communities or in opposing armed groups. In such cases, women’s bodies are “used as an envelope to send messages to the perceived enemy.” In the Shan Province of Myanmar, where the government has been trying to violently suppress a local rebellion since the mid-1990s, hundreds of women have been systematically raped. In one example, an army major approached a young girl and “asked her about her parent’s [whereabouts] and ordered his soldiers to wait at the edge of the farm and arrest anyone who came to the farm. He then raped [the girl] in a hut several times during the day and at about 4 a.m. burned [her alive] in the hut, and left the place with his troops.”

Comparable violations by Russian soldiers in Chechnya have been reported during “mop up” operations that ensue after rebel Chechen fighters have decamped a town. Of four Chechen women vaginally and orally assaulted by Russian military in February 2000, one purportedly suffocated to death while a soldier sat on her head. In Colombia, paramilitary control of some regions often includes sexual violence and torture of women and girls. Intimidation campaigns are carried out on their bodies, as in one of many cases reported in 2001 to the United Nations Special Rapporteur on Violence Against Women, where a Colombian girl was raped and killed, her eyes and nails then removed, and her breasts cut off.

Particularly in conflicts defined by racial, tribal, religious and other divisions, violence may be used to advance the goal of ethnic cleansing. Public rapes in Bosnia, for example, were used to instigate the flight or expulsion of entire Muslim communities. Forced impregnation, mutilation of genitals and intentional HIV transmission are other techniques of ethnic cleansing. Women in Rwanda were taunted by their genocidal rapists, who promised to infect them with HIV. In Bosnia, Muslim women impregnated by Serbs reportedly were held captive until late term to prevent them from aborting. In Kosovo, an estimated 100 babies conceived in rape were born in January 2000 alone — the International Committee of the Red Cross speculated at the time that the real number of rape-related pregnancies was likely to be much higher. Sometimes attacks on women’s bodies — particularly their reproductive capacities — specifically target perceived rival progeny. One woman from Darfur reported in 2004, “I was with another woman, Aziza, aged 18, who had her stomach slit on the night we were abducted. She was pregnant and was killed and they said, ‘It is the child of an enemy.’

Sexual slaves to armed combatants

Many other instances have been identified where women and girls are abducted for the purposes of supplying combatants with sexual services. According to one soldier from DRC, “Our combatants don’t get paid. Therefore they can’t use prostitutes. If we politely ask women to come with us, they are not going to accept. So, we have to make them obey us so we can get what we want.” An elderly victim from Liberia, thought to be around 80 years old at the time she related her story to investigators, acknowledged being held by rebels in the town of Voinjama, where “at night, the men would come, usually more than one. They would rape me. They said they would help me. If I was lucky, they gave me 10 Liberian dollars (US 20 cents).”

More often the victims of sexual slavery are younger, and in many cases their victimisation comes under the terms of military duty. An estimated 40 percent of child soldiers around the world are girls, the majority of whom are forcibly or coercively conscripted. Their responsibilities may range from portering to active combat, with the additional expectation that they will provide sexual services to their superiors or fellow combatants. Much of the violence reportedly committed against women and girls by guerrilla groups in Colombia, for example, is in the context of forced recruitment.

Even those women and girls who “voluntarily” join fighting forces are unlikely to anticipate the extent to which they will suffer sexual exploitation. Data collected in 2004 from women participating in Liberia’s disarmament and demobilisation programme indicated that 73 percent of the women and girls experienced some form of sexual violence. In Uganda, a former child soldier of the National Resistance Army remembers:

“We collected firewood; we carried weapons. For girls it was worse because … we were girlfriends to many different officers. … At the end it became, like, I don’t own my own body, it’s their body. It was so hard to stay the 24 hours a day thinking, Which officer am I going to sleep with today?” In a similar account from a 19-year-old woman voluntarily associated with the Maoists in Nepal, “Sometimes we are forced to satisfy about a dozen [militia] per night. When I had gone to another region for party work, I had to have sex with seven militia and this was the worst day of my life.”

Some girls who are forced or coerced into sexual slavery may succeed in escaping their captors only to be seized again. Such was the experience of 16-year-old “Hawa”, from Sierra Leone:

“There were about 20 men. We ran to the bush, but I got separated from my family. I was with other people from the village, and we were captured by the rebels and taken to Liberia. … At first I refused to be a ‘wife’, but I had to agree because there was nobody to speak up for me, and nobody gave me food except the rebels. I was a wife for about eight months. … I had not even started my periods.”

Hawa eventually escaped and walked for three days in the bush until she got to a town where she found her parents. When they returned together to their remote village, Hawa recalled, “It was very sad when I … met my sisters because I felt I was somehow discriminated against because I had been raped.” Two years later, Hawa recaptured: “It was a different group: This time I was always with them at night as their wife.”

Hawa escaped a second time and was reunited with her family. For too many other women and girls who attempt to escape the perils of war, the threat of sexual violence follows them — from flight, to displacement in camps or other settings, through to their return and resettlement in their home communities.

Flight

The United Nations High Commissioner for Refugees (UNHCR) estimated the total number of people displaced by armed conflict in 2004 at 34 million: 9.3 million were refugees in neighbouring states, and another 25 million were internally displaced in their home countries. According to the United Nations Secretary-General, “The differential impact of armed conflict and the specific vulnerabilities of women can be seen in all phases of displacement.”

During flight, women and girls remain at high risk for sexual violence — committed by bandits, insurgency groups, military and border guards. Many women must flee without the added safeguard of male relatives or community members, further increasing their vulnerability. In the case of 17-year-old “Tatiana” from the DRC, the results were devastating: Tatiana was eight-and-a-half-months pregnant when her husband and her two-year-old son were hacked to death by irregular militia in May 2003. When she, her mother and two younger sisters heard that the same militia intended to raid the district of Bunia, where they lived, they fled. Six days later, they reached a militia checkpoint, but her mother could not pay the $100 demanded. The militia cut her throat, killing her. When Tatiana’s 14-year-old sister began to cry, she was shot in the head.

Her other sister, age 12, was taken to a nearby clearing and gang-raped. Tatiana was told to leave at once or suffer the same fate. After six days walking, she went into labour and gave birth to a girl. Although she had lost a lot of blood, she had to take to the road again the following day. The baby later died.

Without money or other resources, displaced women and girls may be compelled to submit to sex in return for safe passage, food, shelter or other resources. Some may head towards urban settings, possibly in search of the relative security of a densely populated area or in the hope of obtaining employment. Whatever the motivation, both internally displaced and refugee women and girls in urban settings are at risk of exploitation by local residents, especially because they are less likely than encamped populations to be targeted for assistance and protection by governments or by humanitarian agencies.

Afghan refugee women living in the city of Peshawar, Pakistan, for example, described being forced to exchange sex for rent-free housing. In Colombia, the Ministry for Social Protection reported in 2003 that 36 percent of internally displaced women in the country had been forced by men into having sexual relations. This statement was later confirmed in a study undertaken in the same year, which found that displaced women living in barrios in or near the city of Cartagena had suffered higher levels of physical and sexual violence after their displacement.

Unaccompanied girls are likely to be among the most vulnerable to sexual exploitation. A 1999 government survey of over 2,000 prostitutes in Sierra Leone found that 37 percent of the young women were under the age of 15, and that the majority of them had been displaced by conflict and were unaccompanied by family. Still others attempting to escape from war may be the target of traffickers. The absence of border controls and normal policing make conflict-affected countries prime routes for traffickers. In Colombia, the ongoing internal conflict has given rise to one of the western hemisphere’s most active trafficking networks. Colombia’s Department of Security estimated that 35,000 to 50,000 women and girls were trafficked in 2000, the majority to countries in Asia and Western Europe, as well as to the United States.51 Myanmar, also wracked by long-standing civil conflict, is thought to supply some 40,000 trafficked women and girls annually for work in brothels, factories and as domestic labourers in Thailand.

Displacement to camp settings

Camps for internally displaced persons (IDPs) or refugees may offer only limited protection from sexual violence. Humanitarian aid workers have consistently identified the danger to women who must venture far outside the confines of camps to search for firewood or other staples unavailable in the camp. Research undertaken almost 10 years ago among refugees living in camps in Dadaab, Kenya, found that more than 90 percent of reported rapes occurred under these circumstances. Despite the long-standing evidence, however, not enough has been done to anticipate and avert this predictable risk in more recently established camps.

One 27-year-old Liberian woman who had been raped twice before seeking safety in an IDP camp described the circumstances of her third rape, in 2003, when she left the camp to look for firewood:

“There were three government soldiers with guns. One of them saw me and asked, ‘Where are you going?’ I said I was looking for wood. Then he told me, ‘You are assigned to me for the day.’ I was very afraid. He forced me to go far into the bush, and he undressed me. Then he raped me. When I got dressed afterwards, he took 50 Liberian dollars from me. … My stomach is very painful, but I don’t have any money to go for treatment.”

The trend continues for encamped women displaced by the conflict in Darfur, Sudan, but in this instance, repeated reports by a number of international human rights organizations resulted in recent efforts to improve policing and security related to firewood collection. For many women, however, these security measures have come too late. Women are also at risk of rape in or near camps, particularly when the camps are poorly planned and/or administered. In a 1996 survey of Burundian refugee women displaced to a camp in Tanzania, more than one in four reported being raped during the prior three years of conflict, with two-thirds of the rapes occurring since displacement, either inside or close to the camp. The majority of perpetrators were other refugees (59 percent), followed by local Burundian residents (24 percent), and then local Tanzanians, soldiers and police. As with firewood collection, advocates and humanitarians have for several years spoken out about the relationship between ill-considered camp design and violence against women, and have put forth recommendations for reducing women’s vulnerability.

Nevertheless, the problem persists in many settings. A risk assessment carried out in 2004 in seven IDP camps in Montserrado County in Liberia concluded that overcrowded conditions, insufficient lighting at night, the close proximity of male and female latrines and bathhouses, and poor or unequal access to resources all conspired to increase the likelihood of sexual violence against women and girls. In a study undertaken in Northern Uganda, also in 2004, a woman living in one of many IDP camps in the region told investigators, “Rape is rampant here…a woman was recently harassed by two men who held her legs wide open and used a flashlight to observe her private parts and allowed another man to rape her while they observed.

Lack of institutional protection

Not unlike rape in war, these acts of violence flourish in the environments of impunity that too often circumscribe the lives of displaced populations. The problem can be especially dire for IDPs. Despite the fact that in 1998 the United Nations produced guiding principles on the protection of displaced populations, there is still no United Nations agency specifically mandated with their care and protection. UNHCR is increasingly stepping up to fill the void, but in 2004 the refugee agency assisted only 5.6 million of the estimated 25 million internally displaced persons around the world. More often, the responsibility for IDPs falls primarily to national governments, whose resources are likely to be drained or diverted by the conflict. A global evaluation of the reproductive health of refugees and IDPs by an interagency working group found that reproductive health services are most lacking among IDP populations, of which services addressing gender-based violence are the least developed.

The scenario may be only marginally improved for refugees. In too many instances there are not enough UNHCR staff on the ground who are designated to address the issue of gender-based violence. Even where staffing is sufficient, UNHCR’s ability to provide sustained protection against sexual violence is all too often only as good as a host country’s commitment addressing the issue of gender-based violence. Wherever a host government or local community is hostile, the risk of all forms of violence against refugees – including sexual violence – is higher.

Following a statement issued in 2000 by the president of Guinea, for example, in which Liberian and Sierra Leonean refugees were blamed for sheltering armed rebels responsible for attacks on Guinea, women and girl refugees reportedly raped in mob reprisals launched by Guinean police, soldiers and civilians. Some 50 Burundian refugee women in Tanzania allegedly were attacked in May 1999 by a group of over 100 Tanzanian men who were apparently avenging the death of a local schoolteacher. Thousands of Afgans in Pakistan and Burmese in Thailand have never been granted official refugee status by their host governments. The fear of forced return means that they are unlikely ever to report a case of sexual violence committed against them to local authorities. Not surprisingly, in both Pakistan and Thailand multiple incidents have been recounted by refugee women and girls of local police or security colluding in or even perpetrating sexual violence against them.

What is perhaps more surprising is the extent to which humanitarian actors – those whose commitment is to provide assistance – have been implicated in sexual crimes against refugees and IDPs. A 2002 report jointly published by Save the Children (UK) an UNHCR documented allegations against 67 individuals working in 40 aid agencies serving refugees in three countries in West Africa. One young refugee mother told researchers, “I have to sleep with so many men to make 1,500 GNF (37 cents) so that I can feed myself and my child. [The locals] pay me 300 (7 cents) each time, but if I am lucky and I get [an aid] worker, he can pay me 1,500.” Another refugee suggested, “In this community, no one can access CSB [a soy nutrient] without having sex first”. Although a United Nations-sponsored investigative team following up on the allegations questioned the verity of the report, multiple subsequent incidents of sexual exploitation by aid workers in camps in Kenya, Zimbabwe and Nepal, among others, have continued to draw attention to the seriousness of the problem.

Reconstruction or exploitation?

Evidence suggests that sexual violence does not necessarily end with the cessation of armed conflict. Incidents of rape are reported to have increased sharply in the context of ongoing insecurity in post-war Iraq, for example. One of the victims, “Dalal”, was abducted, held overnight and allegedly raped in 2003 by four Iraqi men who she believes “wanted to kidnap anyone…to take what they wanted.” In other post-conflict settings, incidents of rape may decrease, but risk of exposure to forced or coerced prostitution, as well as trafficking, may increase. Events in the Balkans — where prostitution and trafficking burgeoned in the aftermath of wars in the former Yugoslavia — illustrate how criminal elements may replace fighting factions in the continued sexual victimisation of women and girls. The added presence of peacekeeping forces, who have been implicated as users of commercial sex workers in places such as Bosnia-Herzegovina, Sierra Leone, Kosovo, Timor Leste and the DRC, may supply a notable portion of local demand.

In many instances, the risk to women and girls of falling prey to sexual exploiters is exacerbated by reconstruction programmes that fail to specifically target their needs, or to address long-standing patriarchal traditions that discriminate against women. After the genocide in Rwanda, for example, inheritance laws barred surviving women and girls from accessing the property of their dead male family members unless they had been explicitly named as beneficiaries. As a result, thousands were left with no legal claim to their homes and land. Such impoverished women, returning to their communities without family or resources, are more likely to be caught up in the sex trade.

Ironically, and sadly, women and girls who experienced sexual violence during conflict are probably the most vulnerable of all to further exploitation in post-conflict settings. Some rape victims may be rejected by their families and communities for having “lost their value.” In Burundi, women who had been raped told researchers in 2003 that “they had been mocked, humiliated and rejected by women relatives, classmates, friends and neighbours because of the abuse they had suffered.” Raped women may be abandoned by husbands who fear contracting HIV, or who simply cannot tolerate the shadow of “dishonour” they believe their raped wives have cast across them. Without prospects for the future, prostitution may seem the only viable option to these women.

For other women and girls, their histories of victimisation may dull them to the dangers of entering the sex trade. One young girl in Sierra Leone who previously had been abducted by rebels voluntarily became a prostitute after she was released by her captors. She reportedly “considered herself fortunate that she was now being paid.” In Rwanda, an HIV-positive woman in Kagali spoke of her sister’s resignation: “After the war, we saw our family decimated … my little sister for whom I care is a pseudo-prostitute because she has no money. She says that she will continue this lifestyle even is she becomes HIV-positive. She says she looks at my health degrading and insists that she wants to taste life before she dies.” Disregard for one’s own wellbeing is only one of the many potential devastating effects of sexual violence on its survivors.

Rape is a pandemic of huge proportions that affects millions of people across the globe. The perpetrators are almost exclusively male and the victims predominantly women and girls. Their victims may be infants, adolescents, women in their reproductive years and older women. Men and boys are also raped in high numbers, usually by heterosexual males. Rape may happen in the context of “dating”, in marriage, or as part of gang initiation. Rape is widespread in areas of civil unrest and where the rule of law is weak. Rape and sexual abuse are also rife in protected and “captive” environments such as prisons, refugees and displaced person’s camps, the armed services and schools.

Countries of recent notoriety for high numbers of reported rapes are South Africa and the Democratic Republic of Congo, but the rates of rape in India, the United States and many other countries are equally high. Research shows that amongst developed countries the United States has unusually high levels of rape. In 1980 the rate of unreported rape in the United States was 18 times higher than the corresponding rate for England and Wales. More recent data from the State Department of the United States in 2000 indicated that a woman is raped in that country every 90 seconds. According to a 2002 study in Ireland, 6.4 percent of the female population reported having been raped.

Cultural definitions of manhood that stress the importance of sexual conquest and potency place women at increased risk of sexual assault. Many rapist do not consider their aggressive or coercive tactics to be criminal and often feel justified in forcing a woman into having sex. Studies have shown that men do not place as great a value on sexual consent as women.

The act of sexual violence may be motivated by different impulse depending on the rapist and the social or political context in which the violation is performed. Many researchers have concluded, however, that rape is essentially an expression of power rather than an act committed for sexual gratification. They argue that while sexual arousal and even sexual gratification may be a by-product of rape, sex serves as the medium through which perpetrators of rape both demonstrate and exercise control over their victims.

Even when acting according to the same basic impulse, rapists are as varied as those who are raped, and efforts to pin down specific characteristics of rapists are inconclusive. Despite the popular representation of rapists as “sick” or depraved monsters, studies have shown that fewer than 5 percent of men were “psychotic” when they raped. The central assumption in the psychopathological model is that violent male sexual aggression is strange or abnormal, but by the prevalence of rape and the range of perpetrators links sexual aggression, instead, to social and environmental variables.

A study of 114 convicted and incarcerated rapists in the United States revealed a range of motivations from the perpetrators’ perspective. A number of rapists used sexual violence in revenge against another male and/or as punishment – by abusing another man’s woman they punish the man – while others used it as a means of gaining sexual access to unwilling or unavailable women. In one example, a man had an argument with the victim’s husband. “I grabbed her and started beating the hell out of her. Then I committed the act. I knew what I was doing. I was mad. I could have stopped but I didn’t. I did it to get even with her and her husband.

In some cases perpetrators said that rape was just a “bonus” added to burglary or robbery. The rapists found themselves in a position of power and the opportunity presented itself. One man interviewed said, “Rape was a feeling of total dominance. Before the rapes, I would always get a feeling of power and anger. I would degrade women so I could feel there was a person of less worth than me.”

Rape also was considered by some to be a recreational activity. The act was described as an adventure and an exciting form of impersonal sex which gave the rapists power over their victims. A common thread in these interviews was the objective of dominance. The analysts of this study concluded, “The pleasure these men derived from raping reveals the extreme to which they objectified women. Women were seen as sexual commodities to be used and conquered rather than as human beings with rights and feelings. Researchers came to the final conclusion that perhaps they were asking the wrong question. “Instead of asking men who rape “why?” perhaps we should be asking men who don’t “why not?”.

Organized rape can be used as a tactical device to accomplish particular political and social ends. It may be used to intimidate, to punish individual woman and social groups, to destabilize and demoralize communities or to drive unwanted people from their land. Conflicts in the last decade in the Balkans and the present atrocities in Darfur, western Sudan, as well as the mass rape women and girls during the 1994 genocide in Rwanda are examples of rape being used to achieve these kinds of ends. Man may be forced at gunpoint to rape female family members or other men, as part of the use of rape to terrorize and humiliate people.

The perpetrators in these cases are a wide range of men, uniformed and civilian, who act with the tacit or explicit approval of their political or military leaders. While many rapists in these contexts may claim, after the event, that they were coerced into committing rape, there is a long history of rape being seen and enjoyed as the spoils of war.

“Rose”, age 10, at her home in Nairobi, Kenya, just down the road where she and her three girlfriends were raped in July 2005. It is Monday afternoon, and most children Rose’s age are in class. But like many school-aged rape victims, Rose refused to go to school since being assaulted two months earlier. “The teachers will beat me,” she says. “They will beat me and laugh at me, and the other children will laugh at me. They know what happened.”

“One afternoon, four of us were playing outside by the road, and a local vender offered us some mandazi [fried dough]. We always saw him making and selling mandazi. He lives close to us, with his wife and kids. The man told us that he was not feeling well, that he was sick and couldn’t eat any mandazi that day. He said that we could have them, and that we should go and eat them at his home.

“One of the girls went with him. Then he told us, “I do not have any water in the house. Please go and get water for me.” We each took a jerrican and went to get water. He asked us to take it into the house. When we were all inside, he locked the window and locked the door. Then he told us to take off our clothes. We started screaming. He went and got a knife. He said, “Be quiet! Be quiet!” He said he would cut us if we did not stop screaming. We did not want to be killed, so we kept quiet. He undressed the first girl and told her to lay on the bed. He told us three to stand in front of the bed and watch. Then he slept with her. When he finished he picked the next girl, who refused to undress. When she refused, he told her he would stab her. So the man undressed her. He finished with the second girl, and she got dressed. I was the third person…When my turn came I started feeling afraid. I refused to take off my clothes. When he said he would stab me I was scared…He used force with the last girl. Afterwards, he opened the door and warned us that if he heard what had happened from anyone in the community, he would kill us.”

Rose did not return home until 9 p.m. that night, and her mother had been worried. When asked where she had been, Rose talked about the man, but was vague about what had occurred and reluctant to admit that she herself had been raped. At first, none of the girls disclosed exactly what had happened to them. When one of them was asked why she was walking funny, she said that she had been kicked in the leg. The mother of the fourth girl noticed some bleeding from her daughter, a result of the force the rapist used. Eventually, when their story was pieced together, the father of one of the girls took them to the police station to report the rapes and to identify the perpetrator, who admitted to “having the urge to have sex” but denied having penetrated the girls. The four girls were treated at Nairobi Women’s Hospital, where they underwent forensic examinations. The perpetrator was arrested and held in remand until the trail in October 2005.

…Before the assaults, one of the four girls was already enrolled in a community health programme for children who are HIV-positive.

The United Nations Children’s Fund (UNICEF) estimates that one million children around the world enter the sex trade every year, the majority of them girls. The International Labour Organization’s figures from 2000 indicated that 1.8 million children were being exploited in prostitution and pornography worldwide, with girls representing 80 percent to 90 percent of the victims in most countries. Other estimates have put the number of children engaged in sex work significantly higher, closer to 10 million.

Global approximations such as these are really nothing more than educated guesses. The clandestine nature of commercial sexual exploitation, coupled with the fact that many of the world’s sexually exploited children exist in society’s blind spot, meaning that untold numbers of these children – the majority of whom are poor, uneducated, homeless and rejected by society – will never be captured in any statistic. These are just three of their stories:

“Rachel”, a 12-year-old who worked in a local cigarette factory, was taken to Italy and forced to work as a prostitute by her 29-year-old husband three months after they married. If she refused to sell herself on the streets, he beat her. “I worked morning to night every day,” said Rachel, who serviced as many as 10 clients daily to earn the US $250 that her pimping husband demanded of her.

“Sarah”, from the United States, was 10 years old when she was sexually molested live on camera by her friend’s father. The camera was connected to his computer, which allowed him to take simultaneous instructions from members of an Internet-based pedophile club about how to molest her. He later traded the images on the Internet.

“Saida”, a Kenyan, dropped out of school when she was 15 to take care of her sick mother. After her mother died, Saida began cooking and selling beans to help support her siblings. Once, when the family had no food, Saida agreed to have sex with the young man in her neighborhood, with the understanding that he would give her money in return. According to Saida, “He gave me 300 to 500 shillings [approximately $4 to $7] when I slept with him, and this helped. But I worried about diseases since I knew he was sleeping with other women.

Rachel, Sarah, and Saida are among the lucky few managed to extricate themselves from a cycle of abuse. Rachel was rescued by an antitrafficking organization and returned to her family in Albania. She later received financial aid to enroll in a vocational-training programme. Sarah, after initially denying that she had been molested by her friend’s father, disclosed the abuse with the support of her mother. Her testimony in turn assisted the police in sending the perpetrator to jail and led to the first major international police effort to apprehend Internet pedophiles. Women in her community told Saida about a local program to help girls who are either at risk of entering or already engaging in commercial sex work. Through that project, she plans to take a hairdressing course and to get her three younger sisters back into school.

Most sexually exploited children are not as fortunate. Thea Pembroek was six years old when she died of a cocaine overdose while being filmed for one of the many pornographic videos in which she was forced to feature. Few people know of her tragic life and death: “She seems to have been treated in death as little more than the object she had been in life.”

“It was a terrifying experience. When I tried to resist, he pinned my arms above my head. It was so painful and suffocating that I fainted, for I only remember getting up in the morning and finding stains of blood on the bed sheet.” Thirty-two-year old “Laxmi” is remembering the sexual abuse she experienced as age 13. While her description captures the fear and violation associated with rape, what she is describing is her wedding night: The attacker was her adult husband.”

“While it is widely accepted that child sexual abuse exists in virtually all societies around the world, varied cultural practices lend different interpretations to its meaning. These ethnic disparities make understanding and addressing the global problem of sexual abuse against children a daunting task.”

The term “child sexual abuse” generally is used to refer to any sexual activity between a child and a closely related family member (incest) or between a child and an adult or older child from outside the family. It involves either explicit force or coercion or, in cases where consent cannot be given by the victim because of his or her young age, implied force.

What constitutes sexual abuse varies across cultures, and legal interpretations of the age of consent also differ. Where laws stipulate an age, the range is from 12 to age 16, in a few countries, up to age 18. While some experts consider peer assault among minors to be within the realm of child sexual abuse, many laws do not recognize this type of violence as such unless there is a significant age difference – usually three or more years – between those involved.

Determining the scale of child sexual abuse worldwide is complicated, not only because it is difficult to define the abuse cross-culturally, but also because of its hidden nature. Children typically do not have the wherewithal to defend themselves against abuse, and they often lack the resources to report or even acknowledge their victimization. In many instances, a victim’s dependent relationship to the perpetrator makes it that much more unlikely that the abuse will be reported. Protective surveillance – either by parents, caregivers or health, social and child welfare systems – is also challenging because many sexually abused children do not have visible injuries. Detecting such mistreatment “requires a high index of suspicion and familiarity with the verbal, behavioural, and physical indicators of abuse. As such, most victims of child sexual abuse suffer in silence.

Nature and scope

Methodological and ethical challenges associated with interviewing young children make research into child sexual abuse difficult. As a result, most population-based analyses are retrospective: Adults (age 18 and older) and, in an increasing number of surveys, adolescents (usually age 15 or over), are asked whether they had ever been exposed to “unwanted” sexual activity during childhood. “Childhood” in these studies varies from under 18 years of age to under 12 years of age. Unwanted sexual activity is often broken out by researchers into two main categories: “contact” abuse, including vaginal or anal penetration with a penis, finger or an object, or giving or receiving oral sex; and “noncontact” abuse, such as being forced to watch pornography, to disrobe or to view each other’s genitalia.

Outcomes of these studies vary widely. According to data collated from 25 countries worldwide, estimates of exposure for girls range from as low as 2 percent in Samoa and Serbia and Montenegro to 30 percent or higher in Barbados, Costa Rica and Switzerland. For boys, estimates range from 1 percent in Norway to 20 percent in Nicaragua. It is generally impossible to compare these statistics because none of the research is standardized. Exactly what constitutes child sexual abuse and types of abuse are included differs from study to study. Based on available data, the World Health Organization estimates that approximately 25 percent of girls and 8 percent of boys around the globe have been subjected to some form of child sexual abuse. Given its hidden nature, these numbers most likely underrepresent the true scope of the problem.

Regardless of its limitations, the growing body of research on child sexual abuse has shed light on some common characteristics of this type of violence. Girls, for example, are significantly more likely to be abused than boys. In many parts of the world, however, boys may be even less likely to report violence than girls, making the true extent of child sexual abuse against boys a critical area for further study. In one notable survey of secondary school and university students in Sri Lanka, 12 percent of girls reported sexual abuse as children, compared to 20 percent of boys. But these findings are exceptional. A review of international studies found that girls are one-and-a-half to three times more likely to report child sexual abuse than boys. Research from the United States indicates that compared with boys, girls are at twice the risk of sexual victimization throughout childhood and at eight times the risk during adolescence. Police statistics from countries as culturally dissimiliar as Lithuania, South Africa and the United States show that the majority of all reported rapes are committed against girls, a sizable proportion of which are under age 12. In addition research indicates that girls are at a much greater risk of incest than boys. Cross-culturally, from 40 percent to 60 percent of sexual abuse in families involves girls under the age of 15. Perpetrators who abuse boys are more often from outside the family, although in the Sri Lanka research cited earlier, boys identified family members as the primary perpetrators. Both boys and girls with physical and/or learning disabilities are especially vulnerable.

While women do commit sexual violence against children, the vast majority of abusers are men, regardless of the sex of the victim. Contrary to popular perception, few perpetrators are strangers. Most are fathers, stepfathers, grandfathers, uncles, brothers, cousins, neighbours or family friends. They may be men who exploit their positions of power in the community, such as teachers, religious leaders or doctors. They also can be older children and young men – boyfriends, schoolmates or other acquaintances.

The peak age of vulnerability to child sexual abuse has been estimated at between age seven and age 13, but abuse at younger ages may be significantly underreported because of issues of detection, disclosure and, in the case of retrospective studies, recall. Media coverage of “virgin cure” infant rape in sub-Saharan Africa has drawn special attention to the problem of sexual abuse of very young children in that part of the world. The “virgin cure” is certainly not limited to Africa. Evidence suggests that it is currently practised in Asia as well as the Caribbean and apparently was not uncommon in Renaissance Europe. Allegedly related to the myth that intercourse with a virgin girl is a cure for HIV/AIDS and other sexually transmitted diseases, the extent of virgin-cures infant rape has been contested by researchers in South Africa. Its prevalence remains unknown there as well as in other parts of the world, but the effects are unarguably devastating for a baby: “To penetrate the vagina of a small infant, the perpetrators first need to create a common channel between the vagina and the anal canal by forced insertion of an implement…Rape in this manner can be immediately life threatening. The tearing of the perineal body, rectovaginal septum, and anterior anal sphincter can cause infants to die from haemorrhage or abdominal sepsis despite medical care.”

The problem of underreporting

Even if children are able to articulate their experiences and to recognize that they have been violated, they may correctly realize that reporting the abuse could result in rejection by caregivers who are more intent on protecting the family’s reputation than preserving the rights and welfare of the victim. For example, when “Joan” from Zambia finally managed at age 16 to tell her mother that she had been abused by her stepfather since she was nine years old, her mother threw her out of the house. Joan never reported her case to the police.

While parental denial is a cross-cultural phenomenon, the issue of family rejection is all the more distressing for many child sexual abuse victims in sub-Saharan Africa, where a disproportionate number of these children have been orphaned by the HIV/AIDS pandemic. Another 16-year-old girl from Zambia described the dilemma of young girls who have lost their caregivers and are left with very few choices:

“After my mother died, I went to my mother’s mother. In 2001, she died, so I stopped school. …Then we went to my auntie, my mom’s younger sister. …Most girls find they start keeping up [having sex] with stepfathers or uncles. Most are raped – they have no say. They think if you [go] to the police, there will be no one to [take care of them]. So they keep quiet.”

Sometimes reluctance to come forward also can be related to overwhelming fears of punishment by the perpetrator, who may threaten to hurt or kill a child for speaking out. In places where the honour of a family or community resides in the sexual purity of its female members, revelations of child sexual abuse can result in extreme forms of retaliation against a victim, no matter how obvious her innocence. In one case from Pakistan in 1999, a 16-year-old girl with severe learning disabilities who was raped in the Northwest Frontier Province was brought to her community’s judicial council. Even though the crime was reported to the police and the perpetrator was arrested, the council decided that she had brought shame to her tribe, and she was killed in front of a tribal gathering.

In a 1998 study conducted in the United States among children age 10 to age 18, 48 percent of boys and 29 percent of girls who had been sexually abused said they had never told anyone – not even a friend. Those who acknowledge abuse often do so years after it has occurred, by which time the constellation of personal and social problems typically associated with child sexual abuse already may have begun.

Short- and long-term impact

Child sexual abuse has a host of negative physical and psychological repercussions, including reproductive-health problems, depression, suicidal tendencies, anxiety, posttraumatic stress disorder, sexual disfunction and substance abuse. Girls who are sexually abused in childhood may be more likely to engage in sexual risk-taking later in life, compounding their long-term risk of sexually transmitted diseases and early pregnancy. One study from the united States found that girls who experience childhood sexual abuse are nearly three times more likely than nonvictimized girls to become pregnant before age 18.

Of the various forms of child sexual abuse, studies show that forced abuse and penetration, repeated incidences of abuse and parental incest have the most severe impact on victims. Another factor that worsens severity is a marked age difference between the victim and perpetrator. Lack of support from family members or caregivers also increases the potential for distress among child abuse victims. On the other hand, a positive response can bolster a child’s natural resiliency and coping skills. Unfortunately, in too many instances, children do not receive the support they need.

Protection and prevention

The Convention on the Rights of the Child, adopted by the United Nations in 1989 and ratified by every member state except the United States and Somalia, requires countries to “undertake to protect the child from all forms of sexual exploitation and sexual abuse” and further obliges them to “take all effective appropriate measures with a view to abolishing traditional practices prejudicial to the health of children. In acknowledging and respecting cultural differences, however, the Convention does not specify a universal age for sexual consent, nor does it delineate harmful traditional practices. A “child” or “minor” is defined as “every human being below the age of 18 years unless, under the law applicable to the child, majority is attained earlier.” As a result, while the Convention is one of the most accepted and effective of all international agreements, its directives regarding child sexual abuse may be open to cultural interpretation, allowing some of the practices that promote child sexual abuse to continue.

In the words of one expert, “There is a sense in which abusers often extend, rather than reject, socially tolerated attitudes toward adult-child relations.” Given that girls are at a significantly greater risk than boys of child sexual abuse, it is probably also true that male abusers of girls are reinforcing, rather than rejecting, socially accepted gender norms related to male dominance and violence. One glaring example of this was a widely publicised case at a secondary school in Kenya in 1991, where 19 schoolgirls were killed and 71 other were raped by a gang of male students. In her comments about the incident, the deputy principal stated, “The boys never meant any harm against the girls. They just wanted to rape.”

Perceptions that condone and reinforce gender-based violence exist even among those working in the systems whose stated purpose is to protect and assist victims. Within health and social-services sectors, the judiciary and low enforcement, discriminatory attitudes may limit, or even preclude, appropriate response. In South Africa, for example, where a notoriously small proportion of sexual-assault incidents are reported to police, a 2002 study found that cases involving girls age 11 to 17 are often “treated as suspect” because of the belief that these older girls are sexually active and, therefore, potentially complicit.

The conviction rate for all rapes reported to the police, whether of a child or an adult, is around 7 percent in South Africa. In the United States, it is approximately 16 percent of reported cases – but when estimates of unreported rapes are factored in, only 6 percent of all rapists are likely to go to jail. Convictions for child rape are especially challenging because of issues of evidentiary substantiation. Even so, the burden of proof may sometimes be so extreme as to beg the question of whether social customs that condone violence at least partly contribute to the failures in child protection, as in this case from Nigeria:

“Sometime in 1999, an uncle sexually assaulted [his niece] of sex years. The matter was taken to court and prosecuted. In giving judgment, however, the magistrate set the accused person free for lack of corroboration. This was in spite of the bloodied panties, the testimony of the mother who noticed the pains while bathing her, and the medical evidence from a government hospital. The magistrate said [corroboration] meant testimony from another person who witnessed the alleged act…”

Thus, any efforts to address child sexual abuse must include building the capacity of law enforcement and the judiciary, as well as social services, to promptly and effectively deal with suspected or confirmed cases. Just as importantly in relation to long-term prevention, states must make a serious effort to understand the motivation behind the behaviour of abusers and put in place appropriate prevention programmes.

In many countries, prevention and response initiatives are already well underway. Nevertheless, many children’s advocates are concerned about how long it may take before these initiatives will yield tangible results. As such, they have turned considerable attention to raising awareness among children, their families and communities. Grassroots activities include public education about the underlying causes of child sexual abuse, parental-monitoring programmes, life-skills workshops for adolescents and support groups for high-risk children. Another widely applied preventive strategy involves school-based education fro children on concepts and skills that promote protection from sexual abuse.

As an institutional entry point for victims and their families, healthcare systems are critically important. An agency’s ability to provide immediate medical support – such as treatment for sexually transmitted diseases, including post-exposure prophylaxsis for HIV/AIDS and, with older girl victims, emergency contraceptions – can do much to limit the potential negative health impacts of the abuse. By treating a victim with compassion and sensitivity, a healthcare provider can also reduce the victim’s immediate distress and act as a role model to family members, whose support is so critical to a child’s recovery.

Sexual abuse of children is a global problem that cuts across class, religious, ethnic and national boundaries. Even in the most remote places, child sexual abuse may be widespread. In the British colony of Pitcairn in the South Pacific, for example, six men – almost half the adult male population of the tiny island – were found guilty in 2004 for sex offences against the island’s girls. The eldest of the convicted men was 78 years old, and the victims were allegedly as young as five years of age. It was the revelations of one victim to a visiting British policewoman that initiated an investigation, which led to other disclosures. According to one woman who used to live on the island, “The girls are treated as though they are a sex thing…men could do what they want with them.” Whereas some islanders defended the practice as a longstanding tradition, conversations with the victims revealed that many of them suffered from depression, insomnia and suicide attempts.

Addressing the epidemic of child sexual abuse requires societies to recognise, rather than minimise or disavow, its impact on victims. Most importantly, states must acknowledge the rights and vulnerability of their children and take measures to protect them. Otherwise, child sexual abuse will remain a silent scourge.”